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1.
Urologiia ; (2): 46-50, 2021 May.
Artigo em Russo | MEDLINE | ID: mdl-33960156

RESUMO

OBJECTIVE: to study the effectiveness of methods of endovascular treatment of May-Turner syndrome and nutcracker syndrome as a cause of varicose veins of the pelvis in men with chronic pelvic pain syndrome. MATERIALS AND METHODS: a comprehensive examination was carried out in 445 men with chronic pelvic pain syndrome. The patients age ranged from 20 to 68 years (mean age 39.5 years). The diagnosis of varicose veins of the pelvis was established in 49 patients, of which 25 had primary varicose veins of the pelvis, in 24 - secondary varicose veins of the pelvis (13 patients with May-Turner syndrome, 11 patients with nutcracker syndrome). The patients with the nutcracker syndrome underwent embolization of the testicular and pelvic veins using the combined sandwich technique. Patients with May-Turner syndrome underwent stenting of the left common iliac vein. RESULTS: In order to assess the technical efficiency of endovascular treatment, control ultrasound was performed at 1, 3, 6 and 12 months. In 100% of cases, throughout the observation period, the patency of venous stents was maintained; in all cases of embolization of the left testicular vein, there was no blood flow in the embolized vein. In order to assess the clinical efficacy of endovascular treatment after 1, 3, 6, 9 and 12 months. after it, patients were questioned using the NIH-CPSI scale and VAS. The most significant changes in clinical manifestations and ultrasound data were observed after 3 months. after endovascular treatment. CONCLUSIONS: Balloon angioplasty and iliac vein stenting in May-Turner syndrome and left gonadal vein embolization in nutcracker syndrome are minimally invasive treatments with a favorable patient safety profile.


Assuntos
Dor Crônica , Embolização Terapêutica , Varizes , Adulto , Idoso , Dor Crônica/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pélvica/diagnóstico por imagem , Dor Pélvica/etiologia , Dor Pélvica/terapia , Pelve/diagnóstico por imagem , Flebografia , Resultado do Tratamento , Varizes/complicações , Varizes/diagnóstico por imagem , Varizes/cirurgia , Adulto Jovem
2.
BMC Cancer ; 21(1): 447, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888074

RESUMO

BACKGROUND: This study investigates the patterns of PET-positive lymph nodes (LNs) in anal cancer. The aim was to provide information that could inform future anal cancer radiotherapy contouring guidelines. METHODS: The baseline [18F]-FDG PET-CTs of 190 consecutive anal cancer patients were retrospectively assessed. LNs with a Deauville score (DS) of ≥3 were defined as PET-positive. Each PET-positive LN was allocated to a LN region and a LN sub-region; they were then mapped on a standard anatomy reference CT. The association between primary tumor localization and PET-positive LNs in different regions were analyzed. RESULTS: PET-positive LNs (n = 412) were identified in 103 of 190 patients (54%). Compared to anal canal tumors with extension into the rectum, anal canal tumors with perianal extension more often had inguinal (P < 0.001) and less often perirectal (P < 0.001) and internal iliac (P < 0.001) PET-positive LNs. Forty-two patients had PET-positive LNs confined to a solitary region, corresponding to first echelon nodes. The most common solitary LN region was inguinal (25 of 42; 60%) followed by perirectal (26%), internal iliac (10%), and external iliac (2%). No PET-positive LNs were identified in the ischiorectal fossa or in the inguinal area located posterolateral to deep vessels. Skip metastases above the bottom of the sacroiliac joint were quite rare. Most external iliac PET-positive LNs were located posterior to the external iliac vein; only one was located in the lateral external iliac sub-region. CONCLUSIONS: The results support some specific modifications to the elective clinical target volume (CTV) in anal cancer. These changes would lead to reduced volumes of normal tissue being irradiated, which could contribute to a reduction in radiation side-effects.


Assuntos
Neoplasias do Ânus/diagnóstico , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Neoplasias do Ânus/radioterapia , Fluordesoxiglucose F18 , Humanos , Imageamento Tridimensional , Metástase Linfática , Estadiamento de Neoplasias , Pelve/diagnóstico por imagem , Pelve/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
3.
J Comput Assist Tomogr ; 45(2): 224-231, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33661158

RESUMO

OBJECTIVE: The objective of this study was to investigate the efficacy of high-intensity focused ultrasound (HIFU) combined with gonadotropin-releasing hormone agonist or levonorgestrel-releasing intrauterine system (LNG-IUS) in treating dysmenorrhea in patients with severe adenomyosis. METHODS: A retrospective analysis was performed on 243 patients diagnosed with severe adenomyosis. Patients were divided into H (received HIFU alone), H-G (received HIFU combined with gonadotropin-releasing hormone agonist), and H-L (received HIFU combined with LNG-IUS) groups. Their clinical results were compared at 3 months, 6 months, and 12 months after treatment. RESULTS: The effective rates of dysmenorrhea relief in the 3 groups after 3 months were 95.24% in the H group, 98.8% in the H-G group, and 94.74% in the H-L group; those after 6 months were 88.10% in the H group, 95.18% in the H-G group, and 84.21% in the H-L group; those after 12 months were 77.38% in the H group, 79.52% in the H-G group, and 96.05% in the H-L group. There was significant difference in effective rates of dysmenorrhea relief among 3 groups after 12 months of treatment, but not 3 or 6 months. In addition, at 12 months after treatment, there were significant differences in the efficacy of dysmenorrhea between patients of different ages or different ablation rates in group H. However, there was no significant difference in the H-G group and the H-L group. CONCLUSIONS: High-intensity focused ultrasound alone is effective in alleviating the symptoms of dysmenorrhea in short term. However, HIFU combined with LNG-IUS improves the therapeutic effect for a longer period.


Assuntos
Adenomiose/terapia , Dismenorreia/terapia , Tratamento por Ondas de Choque Extracorpóreas , Hormônio Liberador de Gonadotropina/agonistas , Levanogestrel/uso terapêutico , Adenomiose/diagnóstico por imagem , Adulto , Dismenorreia/diagnóstico por imagem , Feminino , Hormônios/uso terapêutico , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia
4.
BMJ Case Rep ; 14(3)2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653871

RESUMO

A 30-year-old, multiparous widow, with postpolio residual paralysis, presented with complaints of dull aching abdominal pain for 15 days. Ultrasound showed a mixed echogenic right adnexal mass with free fluid in the pelvis and abdomen. CT abdomen and pelvis revealed partially defined peripherally enhancing collection in lower abdomen and right adnexa suggestive of tubo-ovarian abscess. There was mild ileal wall thickening and few enlarged mesenteric lymph nodes. Ascitic fluid did not show acid fast bacilli and cultures were sterile. Extensive diagnostic laboratory work was done which was inconclusive. Diagnostic laparoscopy could not be performed due to non-availability of elective operation theatre in the COVID-19 pandemic. Presumptive extrapulmonary tuberculosis was clinically and radiologically diagnosed. She was started on daily anti tuberculosis treatment. This case shows us the importance of imaging as a diagnostic tool and as an alternative for laparoscopy in COVID-19 pandemic to diagnose abdomino-pelvic tuberculosis.


Assuntos
Abscesso Abdominal , Doenças dos Anexos , Antituberculosos/administração & dosagem , Tuberculose Urogenital , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/etiologia , Dor Abdominal/diagnóstico , Doenças dos Anexos/diagnóstico , Doenças dos Anexos/fisiopatologia , Doenças dos Anexos/terapia , Adulto , /terapia , Diagnóstico Diferencial , Feminino , Humanos , Pelve/diagnóstico por imagem , Síndrome Pós-Poliomielite/complicações , Tomografia Computadorizada por Raios X/métodos , Tuberculose Urogenital/complicações , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/fisiopatologia , Tuberculose Urogenital/terapia , Ultrassonografia/métodos
5.
Khirurgiia (Mosk) ; (2): 84-87, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570360

RESUMO

Acute hematogenous osteomyelitis (AHO) in adults is a rare disease complicating timely diagnosis. Even greater difficulties are observed in case of pelvic bone lesion. The authors report AHO of the pelvis an adult. Osteomyelitis was complicated by generalized infection and multiple pyogenic abscesses in subcutaneous adipose tissue of the upper and lower extremities. Detection of primary infectious focus was complicated by extreme severity of the patient's condition and low informative value of X-ray and ultrasound at the early stage of disease. Staphylococcus aureus was obtained from blood culture and infectious foci. Surgical debridement along with complex intensive care ensured a positive outcome.


Assuntos
Abscesso , Osteomielite , Ossos Pélvicos , Infecções Estafilocócicas , Abscesso/diagnóstico , Abscesso/etiologia , Abscesso/microbiologia , Abscesso/terapia , Doença Aguda , Adulto , Antibacterianos/uso terapêutico , Desbridamento , Extremidades/microbiologia , Humanos , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/microbiologia , Osteomielite/terapia , Ossos Pélvicos/microbiologia , Ossos Pélvicos/cirurgia , Pelve/diagnóstico por imagem , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapia , Staphylococcus aureus/isolamento & purificação , Gordura Subcutânea/microbiologia
6.
Nat Commun ; 12(1): 1066, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33594071

RESUMO

Pelvic radiograph (PXR) is essential for detecting proximal femur and pelvis injuries in trauma patients, which is also the key component for trauma survey. None of the currently available algorithms can accurately detect all kinds of trauma-related radiographic findings on PXRs. Here, we show a universal algorithm can detect most types of trauma-related radiographic findings on PXRs. We develop a multiscale deep learning algorithm called PelviXNet trained with 5204 PXRs with weakly supervised point annotation. PelviXNet yields an area under the receiver operating characteristic curve (AUROC) of 0.973 (95% CI, 0.960-0.983) and an area under the precision-recall curve (AUPRC) of 0.963 (95% CI, 0.948-0.974) in the clinical population test set of 1888 PXRs. The accuracy, sensitivity, and specificity at the cutoff value are 0.924 (95% CI, 0.912-0.936), 0.908 (95% CI, 0.885-0.908), and 0.932 (95% CI, 0.919-0.946), respectively. PelviXNet demonstrates comparable performance with radiologists and orthopedics in detecting pelvic and hip fractures.


Assuntos
Algoritmos , Aprendizado Profundo , Pelve/diagnóstico por imagem , Médicos , Ferimentos e Lesões/diagnóstico por imagem , Adulto , Idoso , Feminino , Fraturas do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/patologia , Curva ROC
7.
Acad Emerg Med ; 28(4): 394-403, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33606342

RESUMO

OBJECTIVES: Patients resuscitated from an out-of-hospital circulatory arrest (OHCA) commonly present without an obvious etiology. We assessed the diagnostic capability and safety of early head-to-pelvis computed tomography (CT) imaging in such patients. METHODS: From November 2015 to February 2018, we enrolled 104 patients resuscitated from OHCA without obvious cause (idiopathic OHCA) to an early sudden-death CT (SDCT) scan protocol within 6 h of hospital arrival. The SDCT protocol included a noncontrast CT head, an electrocardiogram-gated cardiac and thoracic CT angiogram, and a nongated venous-phase abdominopelvic CT angiogram. Patients needing urgent cardiac catheterization or hemodynamically unable to tolerate SDCT were excluded. Cardiac CT analyses were blinded, but other SDCT findings were clinically available. Primary endpoints were the number of OHCA causes identified by SDCT compared to the adjudicated cause and critical diagnoses identified by SDCT, including resuscitation complications. Safety endpoints were acute kidney injury (AKI) and inappropriate treatments based on SDCT findings. Acute coronary syndrome was the presumed etiology if any major coronary artery had a >50% stenosis without another OHCA cause. RESULTS: SDCT scans occurred within 1.9 ± 1.0 h of hospital arrival and identified 39% (41/104) of all OHCA causes and 95% (39/41) of causes potentially identifiable by SDCT. Critical findings were identified by SDCT in 98% (43/44) of patients that included potentially life-threatening resuscitation complications of liver or spleen laceration (n = 6); pneumothorax or thoracic organ laceration (n = 8); and mediastinal, pericardial, or vascular hemorrhage (n = 3). SDCT exclusively identified 13 (13%) OHCA causes that would otherwise not be identified without SDCT imaging. No inappropriate treatments resulted from SDCT findings. AKI was common (28%) but only one (1%) patient required new dialysis. CONCLUSIONS: This observational cohort study suggests that early SDCT scanning is safe, can expedite the diagnosis of potential causes, and can meaningfully change clinical management after idiopathic OHCA.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca Extra-Hospitalar , Eletrocardiografia , Hospitais , Humanos , Parada Cardíaca Extra-Hospitalar/diagnóstico por imagem , Parada Cardíaca Extra-Hospitalar/etiologia , Parada Cardíaca Extra-Hospitalar/terapia , Pelve/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
8.
Br J Radiol ; 94(1121): 20201276, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33617294

RESUMO

OBJECTIVES: To assess the feasibility of whole-body dual-energy computed tomographic angiography (DECTA) at 40 keV with 50% reduced iodine dose protocol. METHODS: Whole-body CTA was performed in 65 patients; 31 of these patients underwent 120 kVp single-energy computed tomographic angiography (SECTA) with standard iodine dose (600 mgI/kg) and 34 with 40 keV DECTA with 50% reduced iodine dose (300 mgI/kg). SECTA data were reconstructed with adaptive statistical iterative reconstruction of 40% (SECTA group), and DECTA data were reconstructed with adaptive statistical iterative reconstruction of 40% (DECTA-40% group) and 80% (DECTA-80% group). CT numbers of the thoracic and abdominal aorta, iliac artery, background noise, signal-to-noise ratio (SNR), and arterial depiction were compared among the three groups. The CT dose index volumes (CTDIvol) for the thorax, abdomen, and pelvis were compared between SECTA and DECTA protocols. RESULTS: The vascular CT numbers and background noise were found to be significantly higher in DECTA groups than in the SECTA group (p < 0.001). SNR was significantly higher in the order corresponding to DECTA-80%, SECTA, and DECTA-40% (p < 0.001). The arterial depiction was comparable in almost all arteries; however, intrapelvic arterial depiction was significantly worse in DECTA groups than in the SECTA group (p < 0.0001-0.017). Unlike the pelvic region (p = 0.055), CTDIvol for the thorax (p < 0.0001) and abdomen (p = 0.0031) were significantly higher in the DECTA protocol than in the SECTA protocol. CONCLUSION: DECTA at 40 keV with 50% reduced iodine dose provided higher vascular CT numbers and SNR than SECTA, and almost comparable arterial depiction, but had a degraded intrapelvic arterial depiction and required a larger radiation dose. ADVANCES IN KNOWLEDGE: DECTA enables 50% reduction of iodine dose while maintaining image quality, arterial depiction in almost all arteries, vascular CT numbers, and SNR; however, it does not allow clear visualization of intrapelvic arteries, requiring a slightly larger radiation dose compared with SECTA with standard iodine dose.


Assuntos
Artérias/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste/administração & dosagem , Iodo/administração & dosagem , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Abdome/irrigação sanguínea , Abdome/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aorta Abdominal/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Estatura , Índice de Massa Corporal , Peso Corporal , Estudos de Viabilidade , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pelve/irrigação sanguínea , Pelve/diagnóstico por imagem , Imagens de Fantasmas , Estudos Prospectivos , Doses de Radiação , Exposição à Radiação/análise , Razão Sinal-Ruído
9.
Clin Imaging ; 74: 149-155, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33607595

RESUMO

RATIONALE AND OBJECTIVES: To evaluate the imaging capabilities of the REACT pulse sequence in pelvic venous vessels compared to conventional non-contrast pulse sequences. MATERIALS AND METHODS: In addition to routine MRI venography, non-contrast enhanced REACT pulse sequence was performed in 4 healthy volunteers and 21 patients with suspected or known deep venous thrombosis and post thrombotic syndrome. Acquired images were independently interpreted by two MRI radiologists. The sequence performance was subjectively evaluated on a four-point scale regarding the delineation of small peripheral, midsize and large proximal venous vessels, the imaging of vascular pathologies, and the degradation due to artifacts. To evaluate statistical differences in diagnostic accuracy Friedman's test with Dunn's correction was used. RESULTS: REACT depicted the peripheral veins superior to bTFE and T2-TSE with an average score of 3.39 compared to 2.33 in bTFE and 1.77 in T2-TSE. In midsize vessels REACT performed significantly better than T2-TSE (1.94) and bTFE (2.68) with a score of 3.64. For the large proximal vessels REACT (3.39), bTFE (3.33) and T2-TSE (3.56) performed equally without statistical difference. Visibility of venous pathologies was found to be equal between REACT (3.62), bTFE (3.51) and T2-TSE (3.52). The image degradation due to artifacts was rated best in T2-TSE (3.56), followed by REACT (3.39) and bTFE (3.33). CONCLUSIONS: REACT is a promising tool for the visualization of the pelvic venous system using magnetic resonance imaging.


Assuntos
Artefatos , Imagem por Ressonância Magnética , Abdome , Humanos , Pelve/diagnóstico por imagem , Flebografia
12.
Dtsch Med Wochenschr ; 146(2): 104-107, 2021 01.
Artigo em Alemão | MEDLINE | ID: mdl-33465806

RESUMO

MEDICAL HISTORY: A 29 year old woman was introduced to the surgical department with a history of pain in the lower lumbar spine. CLINICAL FINDINGS AND DIAGNOSIS: The cause of the pain was associated with a retrorectal presacral cystic mass. Diagnosis was made by performing a transvaginal ultrasound, a contrast CT scan and MRI of the pelvic. TREATMENT AND COURSE: Open surgery was performed. The histologic findings showed a monodermal cystic teratoma. The postoperative management showed no complications. CONCLUSION: Retrorectal Tumors not associated with the rectum in the small pelvic are rare. These tumors should be surgically removed.


Assuntos
Cisto Dermoide , Neoplasias Pélvicas , Adulto , Cisto Dermoide/diagnóstico por imagem , Cisto Dermoide/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Neoplasias Pélvicas/diagnóstico por imagem , Neoplasias Pélvicas/cirurgia , Pelve/diagnóstico por imagem , Pelve/cirurgia , Tomografia Computadorizada por Raios X
13.
Am J Phys Anthropol ; 174(4): 846-858, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33410519

RESUMO

OBJECTIVES: Three-dimensional (3D) data collected by structured light scanners, photogrammetry, and computed tomography (CT) scans are increasingly combined in joint analyses, even though the scanning techniques and reconstruction software differ considerably. The aim of the present study was to compare the quality and accuracy of surface models and landmark data obtained from modern clinical CT scanning, 3D structured light scanner, photogrammetry, and MicroScribe digitizer. MATERIAL AND METHODS: We tested 13 different photogrammetric software tools and compared surface models obtained by different methods for four articulated human pelves in a topographical analysis. We also measured a set of 219 landmarks and semilandmarks twice on every surface as well as directly on the dry bones with a MicroScribe digitizer. RESULTS: Only one photogrammetric software package yielded surface models of the complete pelves that could be used for further analysis. Despite the complex pelvic anatomy, all three methods (CT scanning, 3D structured light scanning, photogrammetry) yielded similar surface representations with average deviations among the surface models between 100 and 200 µm. A geometric morphometric analysis of the measured landmarks showed that the different scanning methods yielded similar shape variables, but data acquisition via MicroScribe digitizer was most prone to error. DISCUSSION: We demonstrated that three-dimensional models obtained by different methods can be combined in a single analysis. Photogrammetry proved to be a cheap, quick, and accurate method to generate 3D surface models at useful resolutions, but photogrammetry software packages differ enormously in quality.


Assuntos
Imageamento Tridimensional/métodos , Osteologia/métodos , Software , Adulto , Algoritmos , Pontos de Referência Anatômicos/anatomia & histologia , Pontos de Referência Anatômicos/diagnóstico por imagem , Antropologia Física , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/anatomia & histologia , Pelve/diagnóstico por imagem , Fotogrametria/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
14.
AJR Am J Roentgenol ; 216(3): 824-834, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33474986

RESUMO

OBJECTIVE. The purpose of this study is to comprehensively implement a patient-informed organ dose monitoring framework for clinical CT and compare the effective dose (ED) according to the patient-informed organ dose with ED according to the dose-length product (DLP) in 1048 patients. MATERIALS AND METHODS. Organ doses for a given examination are computed by matching the topogram to a computational phantom from a library of anthropomorphic phantoms and scaling the fixed tube current dose coefficients by the examination volume CT dose index (CTDIvol) and the tube-current modulation using a previously validated convolution-based technique. In this study, the library was expanded to 58 adult, 56 pediatric, five pregnant, and 12 International Commission on Radiological Protection (ICRP) reference models, and the technique was extended to include multiple protocols, a bias correction, and uncertainty estimates. The method was implemented in a clinical monitoring system to estimate organ dose and organ dose-based ED for 647 abdomen-pelvis and 401 chest examinations, which were compared with DLP-based ED using a t test. RESULTS. For the majority of the organs, the maximum errors in organ dose estimation were 18% and 8%, averaged across all protocols, without and with bias correction, respectively. For the patient examinations, DLP-based ED was significantly different from organ dose-based ED by as much as 190.9% and 234.7% for chest and abdomen-pelvis scans, respectively (mean, 9.0% and 24.3%). The differences were statistically significant (p < .001) and exhibited overestimation for larger-sized patients and underestimation for smaller-sized patients. CONCLUSION. A patient-informed organ dose estimation framework was comprehensively implemented applicable to clinical imaging of adult, pediatric, and pregnant patients. Compared with organ dose-based ED, DLP-based ED may overestimate effective dose for larger-sized patients and underestimate it for smaller-sized patients.


Assuntos
Doses de Radiação , Monitoramento de Radiação/métodos , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos/diagnóstico por imagem , Tamanho Corporal , Osso e Ossos/diagnóstico por imagem , Criança , Feminino , Idade Gestacional , Humanos , Fígado/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Imagens de Fantasmas , Gravidez , Padrões de Referência , Estudos Retrospectivos , Fluxo de Trabalho , Adulto Jovem
15.
AJR Am J Roentgenol ; 216(2): 453-463, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33325736

RESUMO

OBJECTIVE. The aim of this phantom study was to determine whether low-dose CT of the pelvis can be performed using a dose similar to that used in a standard radio-graphic examination and to ascertain whether CT, with its better delineation of complex structures, has greater clinical value than radiography and therefore will result in improved patient care. Special consideration was given to CT performed using the tin filtration technique. MATERIALS AND METHODS. For dose comparison, an anthropomorphic phantom with 20 thermoluminescent dosimeters, two different CT scanners, and three conventional radiography devices were used. Seven CT protocols (including tin filtration) and four different radiographic examinations were performed. Dose calculations, objective and subjective evaluations of image quality, and figure-of-merit calculations were compared among the techniques. Furthermore, the images obtained were evaluated in a clinical context. Intraclass correlation was determined for the subjective results. RESULTS. The dose values of the tested low-dose CT protocols, in particular those using the tin filtration technique, corresponded to or were only slightly higher than the dose values of conventional pelvic radiographic images obtained in three views. Low-dose CT examinations were rated sufficient for consolidation control and had an informative value that was significantly higher than that of conventional radiography. Tin filtering showed the best results for low-dose CT in terms of combining dose and clinically relevant image quality. CONCLUSION. In this phantom study, low-dose CT was superior to radiography for visualizing and evaluating the dorsal pelvic ring, with only marginally higher radiation exposure occurring when the latest-generation CT systems were used. Tin filtration can improve image quality, create further dose reductions, or provide both benefits.


Assuntos
Pelve/diagnóstico por imagem , Imagens de Fantasmas , Doses de Radiação , Tomografia Computadorizada por Raios X/instrumentação , Humanos , Dosimetria Termoluminescente
17.
Medicine (Baltimore) ; 99(41): e22633, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031323

RESUMO

RATIONALE: Leiomyomatosis peritonealis disseminata (LPD) is a rare benign lesion primarily consisting of smooth muscle cells, which mostly affects premenopausal females. Here, we reported 3 females with LPD (age, 40-48 years) admitted for pelvic masses. PATIENT CONCERNS: All 3 LPD cases received laparoscopic uterine fibroid morcellation at 3, 8, and 14 years ago, respectively. Two cases were admitted for pelvic masses. One case was admitted for recurrent fibroids with pollakiuria. DIAGNOSES: LPD was considered in 2 cases preoperation according to imaging examination, and one of them received ultrasound-guided biopsy of the lesion in the right lobe of the liver. One case was considered as recurrent fibroids preoperation. After surgery, all cases were pathologically diagnosed as LPD consisting of benign smooth muscle cells. INTERVENTIONS: A total abdominal hysterectomy, salpingo-oophorectomy, and debulking was performed for all 3 cases. Intraoperative exploration revealed that the fibroids distributed in the mesentery (3 cases), broad ligament (1 case), omentum (1 case), liver (1 case), and rectus abdominis (1 case). OUTCOMES: No recurrence was found during postoperative following-up (5-12 months). LESIONS: Preoperative diagnosis of LPD is presented as a challenge due to unspecific clinical manifestations. Its diagnosis mainly depends on histopathologic evaluation. Surgery still is the primary treatment for LPD. For patients without reproductive desire, total abdominal hysterectomy, salpingo-oophorectomy, and debulking can be performed, and the affected tissue should be removed as much as possible based on the risk assessment.


Assuntos
Cavidade Abdominal/patologia , Leiomiomatose/patologia , Pelve/patologia , Cavidade Abdominal/diagnóstico por imagem , Adulto , Feminino , Humanos , Laparoscopia/efeitos adversos , Leiomiomatose/diagnóstico por imagem , Leiomiomatose/etiologia , Pessoa de Meia-Idade , Morcelação/efeitos adversos , Pelve/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Ultrassonografia
18.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1364-1367, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018242

RESUMO

The anterior pelvic plane (APP) defined by both iliac spines and the pubic symphysis, is essential in total hip arthroplasty (THA) for the orientation of the prosthetic cup. However, the APP is nowadays still difficult to determine in computer assisted orthopedic surgery (CAOS). We propose to use a statistical shape model (SSM) of the pelvis to estimate the APP from ipsilateral anatomical landmarks, more easily accessible during surgery in computer assisted THA with the patient in lateral decubitus position. A SSM of the pelvis has been built from 40 male pelvises. Various ipsilateral anatomical landmarks have been extracted from these data and used to deform the SSM. Fitting the SSM to several combinations of these landmarks, we were able to reconstruct the pelvis with an accuracy between 2.8mm and 4.4mm, and estimate the APP inclination with an angular error between 1.3° and 2.8°, depending on the landmarks fitted. Results are promising and show that the APP could be acquired during the intervention from ipsilateral landmarks only.


Assuntos
Artroplastia de Quadril , Cirurgia Assistida por Computador , Humanos , Masculino , Modelos Estatísticos , Orientação Espacial , Pelve/diagnóstico por imagem
19.
Rev Med Suisse ; 16(712): 2042-2045, 2020 Oct 28.
Artigo em Francês | MEDLINE | ID: mdl-33112517

RESUMO

Pelvic congestion syndrome is an underdiagnosed disease, defined as chronic pelvic pain lasting more than 6 months, associated with pelvic varicose veins in premenopausal women. Diagnose is based on imagery after exclusion of other causes of pelvic pains. Echography is first line diagnostic modality. Conservative treatment is often insufficient and pelvic veins embolization is required to improve symptoms.


Assuntos
Embolização Terapêutica , Dor Pélvica/complicações , Dor Pélvica/diagnóstico , Varizes/complicações , Feminino , Humanos , Dor Pélvica/terapia , Pelve/diagnóstico por imagem , Síndrome , Resultado do Tratamento , Varizes/diagnóstico , Varizes/terapia
20.
J Postgrad Med ; 66(4): 215-217, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33109783

RESUMO

Once purely the domain of knee surgery, the use of computer-navigated techniques in total hip arthroplasty (THA) is becoming progressively more commonplace. As with the adoption of any new technology-assisted approach, the uptake of navigated THA utilization has heralded a new suite of technique-specific potential complications. One such example - not usually seen with conventional instrumented THA - pertains to complications related to the insertion and use of fixed pelvic array trackers. This case report describes the unusual circumstance of retained local bony debris generated through application of self-drilling, self-tapping iliac crest pins (for rigid navigation tracker placement) being mis-interpreted on advanced imaging - at a hospital site remote from the index surgery - as an aggressive, early-stage, chondrosarcomatous lesion. This case highlights the critical importance of both a general awareness of common imaging findings after navigated THA surgery (whereby tracker pins have been employed) and the value of 'hands on' clinical assessment of patients to allow correlation with suspicious imaging findings.


Assuntos
Artroplastia de Quadril/efeitos adversos , Pinos Ortopédicos/efeitos adversos , Articulação do Quadril/cirurgia , Pelve/cirurgia , Fraturas Periprotéticas/diagnóstico por imagem , Cirurgia Assistida por Computador/instrumentação , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Feminino , Humanos , Imageamento Tridimensional , Pelve/diagnóstico por imagem , Complicações Pós-Operatórias , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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